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Patients infected with a deadly, drug-resistant fungus are dripping with the dangerous germ, which pours into their surroundings where it lies in wait for weeks to find a new victim. That’s according to fresh data reported from the annual meeting of the American Society for Microbiology recently in San Francisco.

Further Reading

The data fills in critical unknowns about how the fungus, Candida auris, actually spreads. The germ is a relatively new threat, considered an emerging pathogen by experts—and it's emerging quickly with an unusual ability to lurk and kill in healthcare settings.

The fungus mostly sticks to healthcare settings, stealing into the blood of vulnerable patients where it causes invasive infections marked by nondescript fever and chills. It’s commonly resistant to multiple drugs, and some isolates have been found to resist all three classes of antifungal drugs, making it extremely difficult if not impossible to cure. Experts estimate that C. auris infections have a fatality rate somewhere between 30% and 60%. It’s hard to say for sure because many of its victims are seriously ill before they get infected, making it tricky to determine an individual cause afterward.

While the threat is clear, much about C. auris infections has been murky—including how it spreads from one victim to another. Researchers have found it loitering on hospital mattresses, furniture, sinks, and medical equipment, but they haven't determined how it got there. Once it is present, however, it’s a tough bug to annihilate. The fungal cells can form tight, hardy clumps that can live on plastics for at least two weeks and can go into a metabolically dormant phase for a month.

Torrential terror

For the new study, researchers at the Centers for Disease Control and Prevention and the City of Chicago Public Health Department tried to pin down how it gets onto those surfaces, which they hope can lead to a way to prevent its dispersal. They conducted their work in a ventilator-capable skilled nursing facility currently battling an outbreak, which started with a single case in March of 2017. Despite rigorous decontamination efforts, including bleaching surfaces and wiping down patients, 71 percent of residents have now tested positive for the fungus.

The researchers hypothesized that the fungus spreads by sloughing off of infected patients’ skin. Although the C. auris usually presents in a bloodstream infection, researchers have found it on the skin of healthy people. And such skin shedding would be a relatively easy explanation for how it scatters in healthcare facilities.

The researchers swabbed the skin of 28 residents and their rooms, fishing for living fungal cells and the strain's genetic fingerprints. They found plenty of both. Residents’ skin was loaded with the fungus, with some skin swab concentrations measuring in at an equivalent of more than 10 million fungal cells per milliliter. Importantly, the researchers found that the amount of fungal contamination in each resident’s room strongly and positively correlated with the amount festering on the resident’s skin. That is, the more skin fungus, the more room contamination.

The finding supports the hypothesis that skin shedding is the primary means by which C. auris gets around. The researchers are hopeful that the data link can help direct better decontamination and infection control efforts.

As of April 30, the CDC reports 654 confirmed cases in 2019 across a dozen states, with 30 additional probable cases. Screening in nine states has identified another 1,207 patients carrying the fungus without an infection.

That's ominous to think about; a fungus that apparently is absurdly resistant to decontamination efforts short of "BURN EVERYTHING!", apparently uses regular ol' skin shedding, the source of so much dust, as a transmission vector, and if it infects sick and weakened people, can be the straw that breaks the camel's back.

The researchers hypothesized that the fungus spreads by sloughing off of infected patients’ skin.

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Importantly, the researchers found that the amount of fungal contamination in each resident’s room strongly and positively correlated with the amount festering on the resident’s skin. That is, the more skin fungus, the more room contamination.

Yuck. Yet another reason to stay away from hospitals and urgent care centers unless you absolutely need to go there.

I'm hoping that's not really a picture of a person holding an open petri disk of this deadly fungus that they think spreads by skin cells shedding, barehanded.

The director of the German National Reference Centre for Invasive Fungus Infections definitely needs help from the internet peanut gallery on proper safety precautions when working with invasive fungus infections.

And people wonder why I don't go to hospitals, and now that all of my relatives who required continuous care have passed, nursing homes. Or even doctor's offices. Unless I'm likely to die already, the chance of getting a bacterial, and now fungal, infection is way too high for my comfort.

(I recognize the irrationality of my view regarding health care facilities, and am sad every time it is reinforced by news like this)

So, are hospital wings going to be like cropland now, where we have to let it sit "fallow" for a month or two for everything to die off before we re-enter and use it, and we just rotate which ones are in use? Seems like waiting a month is the best way to decontaminate equipment. People on the other hand...

So, are hospital wings going to be like cropland now, where we have to let it sit "fallow" for a month or two for everything to die off before we re-enter and use it, and we just rotate which ones are in use? Seems like waiting a month is the best way to decontaminate equipment. People on the other hand...

Basically, yeah. The human skin is a microcosm of various fungi, bacteria, parasites, and other creepy-crawlies, all living off each other and our sweat, skin flakes, and other bodily fluids/bits and pieces.Most of it is either harmless or actually beneficial, but like gut flora, sometimes bad actors move in and make a bad name for everybody.

Did they not know how bad it was in January of 2018 or is that pictured director a Twelve Monkeys fan?

It's not going to go jumping out of the petri dish on its own, so that's a safe enough way to show it off.

What about spores?

Non-sporing fungi. This is a (distant, I'm assuming) relative of the common yeast, and they are so good at moving about without spores they just never really bothered evolving that as a mechanism for reproduction. Yeast mitoses, without needing a spore "seed" state.

So, are hospital wings going to be like cropland now, where we have to let it sit "fallow" for a month or two for everything to die off before we re-enter and use it, and we just rotate which ones are in use? Seems like waiting a month is the best way to decontaminate equipment. People on the other hand...

Waiting won’t help. The article described the spores’ resilience.

Decontamination procedures will adapt.

Adapt...yes, be survivable....no. I don't think I want to be decontaminated by fire.

Non-sporing fungi. This is a (distant, I'm assuming) relative of the common yeast, and they are so good at moving about without spores they just never really bothered evolving that as a mechanism for reproduction. Yeast mitoses, without needing a spore "seed" state.

Well then I hope I never catch that thing (if I don't have it yet). Thanks to a pretty bad dermatitis I lose so much skin each day, everywhere, that I will probably bring down this whole neighborhood and everything on the way to my workplace.

Reminds me of the Andromeda Strain in that each person descending into the lab had to have all their excess skin burned off with a laser. I could see people wanting to visit or workers having this done before coming in...

Non-sporing fungi. This is a (distant, I'm assuming) relative of the common yeast, and they are so good at moving about without spores they just never really bothered evolving that as a mechanism for reproduction. Yeast mitoses, without needing a spore "seed" state.

Well then I hope I never catch that thing (if I don't have it yet). Thanks to a pretty bad dermatitis I lose so much skin each day, everywhere, that I will probably bring down this whole neighborhood and everything on the way to my workplace.

On the plus side, you could earn a good gig that way. "Nice coffee shop you have here. For $100 per week only, I won't come and buy a coffee there. For an extra $10 I'll also bypass the delicious looking muffins you offer as well."

Did they not know how bad it was in January of 2018 or is that pictured director a Twelve Monkeys fan?

It's not going to go jumping out of the petri dish on its own, so that's a safe enough way to show it off.

And supporting neutron-reflecting hemispheres with a screwdriver was "safe enough", too!

Non-equivalent situations. Those spheres were known to be dangerous in ANY configuration, and no safety measures were being used.

A non-sporing fungus, contained in a petri dish, opened by someone who undoubtedly washed their hands with alcohol after touching ONLY the outside of the petri dish (someplace the fungi wasn't), with known properties of the fungi, all perfectly safe unless the Director did something incredibly stupid like lick the petri dish, or shove it into someones face.